Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2
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Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2
) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2eminated disease from another site or as an isolated lesion. In the latter case, it may be difficult to distinguish between a primary tumor of the gynecologic tract or metastases to the gynecologic tract from a nongynecologic site. Because treatment planning and appropriateness of surgery may be dic Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2tated by the primary site of the tumor, it is important to make the distinction between primary and metastatic disease. This chapter focuses on commonEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
sites of metastases to the gynecologic tract, characteristic clinical presentations, and radiologic and pathologic considerations that may be clinica) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2stric, and appendiceal primary malignancies.2Within the reproductive tract, the ovaries and vagina are the organs most commonly affected by metastatic disease.3Malignant masses or lesions in the gynecologic organs should be considered as potential sites of metastases if an established primary malign Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2ancy is of advanced stage or demonstrates poor prognostic factors.Metastatic disease to the genital tract from nongenital tract malignancies is relatiEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
vely uncommon but is influenced by geographic differences in cancer incidence. For instance, in Asian countries where gastric cancer is more common, m) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2gin; in Thailand, where cholangiocarcinoma is quite prevalent, 7% of all metastases to the genital tract may arise from the gallbladder or extrahepatic biliary tract.- A single-institution review from the United States of 445,000 accessioned cases identified 325 metastatic tumors to the genital trac Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2t over a 32-year time period; 149 (45.8%) were from extragenital sites including the colon and rectum, breast, stomach, and appendix. Additional primaEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
ry sites included the bladder, ileum, and cutaneous melanoma. The remaining sites of metastases originated from other areas within the genital tract s) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2es may vary by geographic area, the most common primary sites of disease metastatic to the ovaries typically arise from the gastrointestinal (GI) tract (large intestine and stomach, pancreas, biliary tract, and appendix) and breast. These sites comprise 50% to 90% of the metastatic cancers to the ov Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2aries (Table 17-1). Although the histology of a metastatic breast cancer may look uniquely like breast cancer, metastases from other sites, such as thEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
e pancreas and appendix, are mucinous and can be difficult to distinguish from a primary mucinous tumor of the ovary. Endometrioid-appearing histologi) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2astatic clear cell renal carcinoma. In the case of breast cancer, metastases to the ovary may remain completely occult and are detected only at autopsy or when they become symptomatic to the patient or identified on examination by her physician. With mucinous tumors, the metastases in the ovary can Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2become quite large, leading to significant symptoms and typically dominating the clinical picture for the patient and the clinician.Table 17-1 MetastaEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
tic Tumor to the OvariesPrimary Site of CancerNumber (%)Stomach743 (76)Colon and rectum104(11)Gallbladder/biliary28 (3}Breast44(4)Others’59 (6)Total97) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2atic disease when there is an established nongynecologic primary malignancy especially if the primary tumor is advanced or has poor prognostic factors. This is true of metastatic breast, pancreatic, and colon cancer. In the case of some metastatic Gl tract malignancies, however, the primary tumor ma Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2y not be found for many years after the metastasis. The classic signet ring cell adenocarcinoma of the ovary is called a Krukenberg tumor, which repreEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
sents fewer than 6% to 7% of all ovarian tumors in Western countries. The signet ring morphology was initially described in 1896 by a German pathologi) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2 is the primary site of malignancy in 70% of cases of Krukenberg tumor. The route of spread to the ovaries is believed to be lymphatic due to the copious lymphatic plexus surrounding the gastric mucosa and submucosa. This lymphatic plexus, which communicates with the lymphatics along the ovarian ves Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2sels, provides a direct conduit for even small gastric cancers to spread to the hilum and cortex of the ovary.3Primary appendiceal neoplasms, includinEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
g low-grade mucinous neoplasms, signet ring adenocarcinomas, and mucinous carcinoid tumors, also may remain occult until they present with symptomatic) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2l and contained with fibrotic mucus." When this occurs, the resulting ovarian metastases are frequently bilateral and occur as a result of implantation of tumor cells and mucin on the surface of the ovaries, which can then invade into the stroma. If there is unilateral involvement of the ovary, it i Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2s more frequently on the right side, adjacent to the appendix.5Most patients with colorectal cancer, similar to those with breast cancer, will have thEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
eir primary malignancy detected before the diagnosis of metastatic disease to the ovaries. In colorectal cancers, only 3% of patients initially presen) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2astases, most have a primary lesion in the colon that has full-thickness invasion of the bowel wall, direct invasion into adjacent structures, multiple positive lymph nodes, and/or involvement of other non-ovarian sites such as the omentum or liver.** Although ovarian involvement can occur by direct Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2 extension, other processes such as angio-genesis and stromal cell-cancer cell interaction have been proposed for the predilection of colorectal canceEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
r to metastasize to theovaries. In patients with pancreatic cancer, 4% to 6% will have ovarian metastases during the course of their disease.4 In a sm) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2tery, when the ovarian involvement was detected.-Carcinomas of the extrahepatic bile ducts and gallbladder are far more common in Asian countries. Ovarian metastases may present in a heterogenous manner, with nearly equal number of patients presenting at the time of primary tumor diagnosis and befor Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2e or after detection of the primary tumor site. The vast majority of metastases are bilateral and mucinous, but the tumor may be infiltrative or primaEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
rily present on the surface of the ovaries and can be cystic, solid, or mixed in morphology.-After the gastrointestinal tract, breast cancer is the mo) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2epair genes that predispose women to develop ovarian cancer, distinguishing a primary ovarian malignancy from a metastatic breast or colon cancer in women who harbor these genetic mutations may create a diagnostic dilemma. Nearly 10% of women who develop breast cancer before the age of 50 years will Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2 harbor a mutation in BRCA1 or BRCA2 that will place them at risk for ovarian cancer." Distinguishing advanced primary ovarian cancer from metastaticEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
breast cancer is critical in providing recommendations for the appropriateness of cytoreductive surgery, chemotherapy, or hormonal therapy.In a review) Metastases to the Gynecologic Tracts. Diane Yamada and Nita K. LeeMetastases to the genital tract may occur as a result of recognizable widely disse Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2th primary ovarian, tubal, or peritoneal cancers.-^ Although not statistically significant, the authors suggested a trend favoring a new primary ovarian cancer in women with longer intervals since their breast cancer diagnosis and higher CA-125 values. In autopsy studies, 10% of patients with breast Ebook Gynecologic oncology clinical practice and surgical atlas: Part 2 cancer have ovarian metastases.— The most significant risk factor for ovarian involvement is advanced-stage breast cancer. In a series of 31 patientsEbook Gynecologic oncology clinical practice and surgical atlas: Part 2
with stage IV breast cancer who underwent laparoscopy for either an adnexal mass or therapeutic bilateral salpingo-oophorectomy, 21 patients (68%) weGọi ngay
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